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Emergency department throughput: an intervention

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Abstract

Shortening emergency department (ED) boarding time and managing hospital bed capacity by expediting the inpatient discharge process have been challenging for hospitals nationwide. The objective of this study is was to explore the effect of an innovative prospective intervention on hospital workflow, specifically on early inpatient discharges and the ED boarding time. The intervention consisted of a structured nursing “admission discharge transfer” (ADT) protocol receiving new admissions from the ED and helping out floor nursing with early discharges. ADT intervention was implemented in a 38-bed hospitalist run inpatient unit at an academic hospital. The study population consisted of 4486 patients (including inpatient and observation admissions) who were hospitalized to the medicine unit from March 2013–March 2014. Of these hospitalizations, 2259 patients received the ADT intervention. Patients’ demographics, discharge and ED boarding data were collected for from March 4, 2013 to March 31, 2014 for both intervention and control groups (28 weeks each). Chi-square and unpaired t tests were utilized to compare population characteristics. Poisson regression analysis was conducted to estimate the association between intervention and hospital length of stay adjusted for differences in patient demographics. Mean age of the study population was 58.6 years, 23% were African Americans and 55% were women. A significant reduction in ED boarding time (p < 0.001) and improvement in early (before 2 PM) hospital discharges (p = 0.01) were noticed among patients in the intervention groups. There was a slight but significant reduction in hospital length of stay for observation patients in the intervention group; however, no such difference was noted for inpatient admissions. Our study showed that dedicating nursing resources towards ED-boarded patients and early inpatient discharges can significantly improve hospital workflow and reduce hospital length of stay.

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Acknowledgements

This work would not be possible without the efforts of the ADT nursing team (Christine Barton, RN, CMSRN, MSN, Leilani Turman, RN, CMSRN, Jonathan Espenancia, RN, CMSRN, Shahida Khan, RN, CMSRN, Sol Marte, RN, BSN).

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Authors and Affiliations

  1. Division of Hospital Medicine, Department of Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, MFL Bldg, West Tower 6th Floor, Baltimore, MD, 21224, USA

    Nowreen Haq & Waseem Khaliq

  2. Johns Hopkins Bayview Medical Center, Johns Hopkins University, School of Nursing, Baltimore, MD, USA

    Rona Stewart-Corral

  3. Department of Operations Integration, Johns Hopkins Health System, Baltimore, MD, USA

    Eric Hamrock

  4. Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD, USA

    Jamie Perin

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  1. Nowreen Haq
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  2. Rona Stewart-Corral
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  3. Eric Hamrock
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  4. Jamie Perin
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  5. Waseem Khaliq
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Correspondence to Waseem Khaliq.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Haq, N., Stewart-Corral, R., Hamrock, E. et al. Emergency department throughput: an intervention. Intern Emerg Med 13, 923–931 (2018). https://doi.org/10.1007/s11739-018-1786-1

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  • DOI: https://doi.org/10.1007/s11739-018-1786-1

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